Repeated Implantation Failure


Journey is a roller coaster ride with a happy ending. But for some patients, it is a bumpy ride due to repeated implantation failure (RIF). Repeated implantation failure (RIF) is a condition in which patient is not able to get clinically pregnant after 2 or 3 cycles of IVF procedure.

RIF is most challenging and complex situation for patient and IVF specialist. However, this condition can be manageable by knowing the cause.

There are various factors which cause RIF. Some known factors are:

  1. Egg quality & quantity: Quality and quantity of egg are essential to generate a healthy embryo. There are numerous reasons which reduce quality and quantity of egg are
  • Maternal advanced age
  • Polycystic Ovarian Syndrome (PCOD)
  • Low ovarian reserve
  • Endometriosis
  • ovarian surgery 

2. Sperm quality & quantity: The major role of sperm is to move and transfer DNA into the egg to produce a healthy embryo. Reasons which reduces quality and quantity of sperm are

  • Advanced age
  • Lifestyle (Alcoholism, smoking, obesity, certain drugs etc)
  • Certain diseases (Prostate cancer, diabetes)  

 3.Embryo: Most common factor of RIF is chromosomal abnormalities in embryo due to

  • Maternal advance age
  • An abnormal number of chromosome
  • Abnormal embryo development
  • Thick embryonic zona pellucida

4. Uterine factors: Uterus environment also play a very important role for implantation. Any congenital and non-congenital uterus anomalies may cause RIF are

  • Submucous fibroids
  • Endometrial polyps
  • Intrauterine adhesions
  • Adenomyosis
  • Endometriosis
  • Abnormal uterus shape
  • Endometrial non-receptivity
  • Hydrosalpinges (Fallopian tube filled with water or fluid)

5. Immunological factors: Body immune systemhas a role in embryo implantationand continued pregnancy.

6. Thrombophilic conditions: Inherited or acquired thrombophilic state disturbs the blood supply in the uterus and causes RIF.

All above mentioned causes of RIF can be diagnosed and or manageable; subsequently increase the chances of conceiving by IVF. The diagnostic and treatment of RIF as follows

Causes of RIFDiagnosis and treatment of RIF
Egg quality & quantityTo check ovarian reserve, IVF specialist recommended tests such as basal FSH, anti-Mullerian hormone (AMH) and antral follicle counts
Manage PCOD & treat endometriosis before start of IVF process
Perform karyotyping of a woman to identify any genetic abnormality
Use some technology to choose best quality egg for IVF
During IVF process, IVF specialist recommended ovarian stimulating drugs to obtain quality & quantity of egg
IVF specialists suggest the use of donor egg if maternal age is above 40 years
Sperm quality & quantityRecommended healthy lifestyle and antioxidant to enhance quality & quantity of sperm
Perform karyotyping of man to identify any genetic abnormality
IVF specialist performs high-magnification intracytoplasmic sperm injection (ICSI) or testicular biopsies to select best quality sperm for IVF
IVF specialist suggested the use of donor sperm in case of azoospermia
EmbryoTo check the quality of embryo, IVF specialist recommended preimplantation genetic tests such as PGD/ PGS before implantation
Use assisted hatching process which helps the releaseof the embryos from their zona
IVF specialist transfer the embryo at the blastocyst stage to increases the chance of implantation
Uterine factorsIVF specialist perform HSG test to detect any kind of abnormality in the uterus
To treat submucous fibroids, intrauterine adhesions, abnormal uterine shape & endometrial polyps, IVF specialist perform surgery
IVF specialist performs endometrial scratch and salpingectomy (remove water from the fallopian tube) to improve implantation rate
Treat endometriosis before start of IVF process
Immunological factorsTo check immunological factors, IVF specialist recommended tests such as the natural killer cell, antiphospholipid syndrome
Immunotherapy with intravenous immunoglobulin (IVIG) has been given during IVF process
Thrombophilic conditionsIVF specialist recommended heparin which can help in significantly improving implantation in certain cases

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